What is the right CQC staff ratio for care homes and nursing homes?

CQC staff ratio in care homes 

The CQC does not specify a precise ratio of staff to care home residents. Every care home will have different residents with different needs. If your residents have greater needs, then you will require more staff. This means the staff ratio is something for your care home manager to decide.  

In the past, care homes would be given prescribed staffing ratios to help them determine appropriate staffing levels based on the number of residents. Today the only requirement from the CQC is that the number of staff must be sufficient to meet the CQC’s fundamental standards of care. 

To help you decide what the right staff ratios are for your care home, focus on these three key areas: 

• Feedback from residents, their friends or families, visiting professionals, and staff members. 
• Analysis of accidents or incidents. 
• Observations about how responsive your staff are to the shifting needs of your service users. 

Here are some questions to ask yourself when deciding your staff ratio: 

• What are the needs and wishes of the people you support? 
• Do your staff have enough time to carry out auxiliary duties such as filling in documents, engaging with healthcare professionals, and talking to relatives? 
• What is the impact of environmental factors such as the layout of your care home or location of people who access home care? 
• Are you able to accommodate times where you might need extra staff, such as during busy periods or when certain residents need extra care? 
• Do you rely too heavily on volunteers, inexperienced care workers, or agency workers? 
• Are you accounting for the impact of staff turnover, sickness, and special leave? 
• Have you considered other factors that might affect staff performance, for example fatigue from working long shifts? 

Here are some warning signs that your staff ratio may be inadequate: 

• High staff turnover. 
• Disorganised rota. 
• High call bell response times. 
• Staff have no time for compassionate care. 
• Over reliance on agency workers. 
• Limited time to support or supervise staff. 
• High levels of serious incidents. 

You must review your staffing levels regularly to ensure you continue to meet the needs of your service users, and make the necessary adjustments. In addition, you should do an ad hoc review whenever someone’s needs change or a new resident is admitted. Failure to conduct regular reviews will impact the quality of your care and jeopardise your CQC rating. 

 

CQC staff ratio in nursing homes 

The CQC does not give a required ratio of staff to nursing home residents. Nursing home residents often have more advanced needs than care home residents. In some cases, residents may need exceptional levels of support. The staff ratio is something that must be decided by your nursing home manager. 

When assessing the advanced needs of nursing home residents, consider the following criteria: 

• Mobility: Do they need support? Are they bed bound? 
• Continence: Are they occasionally incontinent, urinary incontinent or doubly incontinent? 
• Bowels: Do they need laxatives or enemas? 
• Breathing: Do they struggle with breathing? Do they use inhalers? 
• Bathing: Can they bathe independently, or do they need assistance? 
• Oral hygiene: Can they care for their own teeth, or do they need assistance? 
• Hearing: Do they suffer from partial or complete hearing loss? 
• Eyesight: Do they have poor eyesight even with glasses? Are they registered blind?  
• Memory: Do they forget past or present events? 
• Sociability: Do they resist social contact? Are they completely withdrawn? 
• Pressure areas: Do they suffer from broken skin or sores? 
• Pain: Do they suffer from severe pain? Do they have analgesia? 
• Mood: Do they suffer from occasional or frequent mood swings? 
• Nutrition: Can they feed themselves, or do they need supervision? 
• Tolerance: Are they verbally or physically aggressive or abusive? 
• Communication: Do they struggle with verbal or physical expression? 
• Dressing: Are they able to clothe themselves, or do they need assistance? 
• Orientation: Can they find their way around or are they completely lost? 

 

Dependency tool for care homes  

Dependency tools for care homes can help care homes to determine how many staff they need for their set of circumstances. They function as a care home staffing calculator and there are several options available that can be found online or at in-person events.  

We don’t recommend a particular dependency tool, but you can find out more by speaking to other providers and seeing what tools they use and recommend. Another option is to invest in or create your own bespoke tool that is tailored to your service’s specific needs. 

While tools can be helpful, providers have the ultimate responsibility of complying with the requirements set out under Regulation 18 of the Health and Social Care Act 2008. Providers should use their judgement on deciding which dependency tool is the most appropriate for their service. The right care dependency tool can help providers make informed decisions about the most appropriate safe staffing levels for their service.  

 

Dependency tools and CQC inspections 

Care home dependency tools provide important evidence during CQC inspections to show how and why the home’s present staffing levels have been decided. The CQC will want to see that the dependency tool considers not just the needs of the people using the service, but also other factors such as the layout of the care home.  

Having a dependency tool is insufficient on its own. Your staff must be able to use the tool competently and consistently. If you use a dependency tool the CQC will check your records to see when your tool was last used, and on what basis the tool makes its calculations. Any shortcomings in this area can lead to the CQC to give an ‘inadequate’ or ‘requires improvement’ rating. 

 

How do dependency tools work? 

Here’s a broad overview of how a typical dependency tool might work to help you determine the right staff ratios for your service: 

 

Categorise residents into levels of dependency 

Group your residents together according to the level of their dependency:  

• Low dependency: Continent. Does not require toilet assistance. Can feed themselves, wash themselves, and walk around without another person’s help. Can manage their own affairs. Able to voice their needs. 
• Medium dependency: Continent, but may have the occasional ‘accident.’ Sometimes may require assistance in the toilet. Can feed themselves. May need assistance with washing or dressing.  
• High dependency: Occasionally incontinent. Requires assistance in the toilet. May need help feeding themselves. Needs help with washing and dressing. Requires help with manging finances. Struggles to voice their needs. 
• Total dependency: Incontinent, sometimes doubly incontinent. Needs assistance in the toilet. Requires feeding, washing and dressing. Cannot manage own affairs. Unable to voice their needs. 

Assign a number of required daily care hours for each level of dependency. 

 

Calculate total number of care hours required  

By adding up the numbers of daily care hours required for each resident, the total number of daily care hours required in your service can be calculated. 

 

Determine the number of care hours available 

The number of daily care hours available in your service can be calculated using this simple mathematical formula: 

Daily care hours available = Total number of hours staff work per day – Time required for breaks, training, or supervision

 

Compare number of care hours required by care hours available 

If your care hours available are equal to or greater than the care hours required, you can generally conclude that your staff ratios are adequate for your service. 

 

Additional considerations 

Of course, real life situations cannot always be boiled down into a simple formula.  

Here are some additional factors that could affect the staff ratios you require: 

• Layout of your building 
• Categories of care (learning disability, mental health, dementia) 
• Contractual agreements relating to staffing levels 
• Staff sickness levels 
• Staff skills  
• Staff turnover 
• Feedback surveys 
• Supernumerary hours and protected learning time 
• Medicines management and pharmacy audits 
• Findings from your CQC inspection reports 

The degree to which each factor might affect your required staff ratio depends on your individual circumstances.  

 

Alternatives to dependency tools 

Although dependency tools have their uses, they also have their limitations. They can be restricted in scope and may not be accurate in certain situations.  

At Access we have been offering solutions to the care sector for over 30 years. We currently serve over 6,000 care homes and over 4,500 community agencies.  

Our care home software enables you to set which skills are required for a given shift, and see which staff have the skills and availability to fill the shift. This allows you to accurately determine the most effective staff to resident ratio for any given situation, without having to rely on a dependency tool. 

Watch this short video to learn how Erskine, the largest care provider to veterans in Scotland, use Access’s software to deliver outstanding care to their residents: 

As a complete care home management solution, our software offers a full set of features covering: 

• Scheduling and rostering 
• Employee management 
• Electronic care management  

To find out more about the care home software we offer at Access, contact us here to discuss your needs or book a demo.